4 January 2011
Are too many coronial autopsies unnecessary?
The number of coroner autopsies carried out every year in England and
Wales could be reduced by over 60% - or 80,000 dissections - if a system
of post-mortem examinations used in Scotland was adopted, say the
authors of a paper published in the January issue of the Journal of the
Royal Society of Medicine.
The authors, led by Professor Derrick Pounder, of the Centre for
Forensic and Legal Medicine at the University of Dundee, argue that
external examinations are a more cost-effective and less intrusive
system for identifying cause of death.
'Currently the autopsy rate for England and Wales is 22% (110,000
coronial autopsies for 500,000 deaths per annum), yet there is a general
lack of evidence about the utility of and justification for such a high
level of activity, which is between double and triple the rate in other
jurisdictions,' say the authors. 'While the autopsy is an important
tool in modern death investigation, an almost automatic recourse to it
is inappropriate. External examinations are not only cost-effective but
also a necessary element in any death investigative system which wishes
to strike an appropriate balance between intrusion by the state and the
rights of the bereaved.'
An external examination, the authors argue, is thorough and includes the
examination of clothing and a head-to-toe examination of the body to
record all identifying features, old and recent injuries, post-mortem
changes, and recent medical intervention including resuscitation
attempts. Minor incisions can be made to obtain samples for toxicology -
for example a short 2 or 3 inch incision in the groin to obtain blood
from a vein for drugs analysis.
Professor Pounder, an internationally-renowned pathologist, leads on the
forensic autopsy service provided by the University of Dundee to Tayside
region. From 1988 a programme was initiated to maximise use of external
examinations in Tayside. This has meant that today the rate of autopsies
is 6%, a rate which, if implemented in England and Wales, say the
authors, 'would reduce the number of autopsies from 110,000 to 30,000
per annum, with all of the social, resource and management
implications.'
They go on to argue, 'A medicolegal dissection, or autopsy, is an
important tool in modern death investigation but we have to remember it
is also an intrusion by the state into what is otherwise the private
matter of the death of a family member.
'The need for the state to seize the corpse and to dissect it for
investigative purposes must be balanced against the rights of the family
to privacy and freedom of religious practice. Quite apart from the issue
of ethics and human rights, the overall cost of autopsies and other
medical and scientific tests is rather more than half the total direct
cost of the coroner service in England and Wales.'
Professor Pounder commented, 'We need fewer autopsies in which we invest
more time to perform them better. We need to change our approach and be
much more thoughtful in selecting which deaths we autopsy, rather than
carrying out autopsies automatically in large numbers of deaths, and
running a production line system.
'Autopsies must be performed by skilled pathologists, and we simply do
not have the people to perform well such large numbers of autopsies. The
inevitable result is a lowering of autopsy standards, and a false sense
of security that we have properly investigated the death. Unnecessary
autopsies in large numbers of deaths rob us of our most precious
resource - the time of skilled professionals.'
The Tayside programme was extended to Fife and Central regions in
Scotland in 2006, with the support of NHS pathologists, and now serves a
population of 1.1 million people and includes three police forces and
nine procurator fiscal offices.
Note to editors:
How can we reduce coroner autopsies? Lessons from Scotland and the
Dundee initiative by authors D Pounder, M Jones, H Peschel is published
in the January issue of the Journal of the Royal Society of Medicine.
Please make sure you mention the JRSM in your copy. Many thanks.
The JRSM is the flagship journal of the Royal Society of Medicine. It
has full editorial independence of the RSM. It has been published
continuously since 1809. Its Editor is Dr Kamran Abbasi.
Derrick Pounder is a forensic pathologist, and has been professor of
forensic medicine at the University of Dundee since 1987, before which
he worked as a medical examiner in Canada and as a pathologist in
Australia. He has acted as an expert for the UN, Council of Europe,
Amnesty International, and several governments worldwide.
For further information, or to contact Professor Derrick Pounder:
Carmel Turner, Royal Society of Medicine Media Office:
020 7290 2904 or 07949 516471
carmel.turner@rsm.ac.uk.
For media enquiries contact:
Roddy Isles
Head, Press Office
University of Dundee
Nethergate, Dundee, DD1 4HN
TEL: 01382 384910
E-MAIL: r.isles@dundee.ac.uk
MOBILE: 07800 581902 |
